title: Scrub typhus meningitis in South India--a retrospective study.
abstract: BACKGROUND
  Scrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reports.
  
  
  METHODS
  A retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness--a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits.
  
  
  RESULTS
  Sixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol.
  
  
  CONCLUSIONS
  Meningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.
authors.affiliation: Department of General Medicine, Indira Gandhi Medical College, Kathirkamam, Pondicherry, India. stalinviswanathan@ymail.com
authors.forename: Stalin
authors.initials: S
authors.lastname: Viswanathan
authors.forename: Vivekanandan
authors.initials: V
authors.lastname: Muthu
authors.forename: Nayyar
authors.initials: N
authors.lastname: Iqbal
authors.forename: Bhavith
authors.initials: B
authors.lastname: Remalayam
authors.forename: Tarun
authors.initials: T
authors.lastname: George
mesh_terms: D000328:Adult; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007194:India / Q000453:epidemiology; D018655:Lymphocyte Count; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000453:epidemiology*; D008875:Middle Aged; D012189:Retrospective Studies; D012612:Scrub Typhus / Q000134:cerebrospinal fluid / Q000453:epidemiology*
chemical_list: D002556:Cerebrospinal Fluid Proteins; D005947:Glucose